Electrophysiological evaluation of tachycardias using transesophageal pacing and recording

Programmed electrical stimulation of the heart to initiate and terminate tachycardia has been useful in the evaluation of supraventricular and ventricular tachyarrhythmias. A wide use of these procedures, however, failed because of the expense of the invasive approach as well as the lack of physician experience in smaller hospitals. These disadvantages of the invasive proceeding can be abolished by transesophageal pacing. In our study, supraventricular tachycardias were initiated by programmed transesophageal atrial stimulation in 251 patients (AV node reentry in 75 patients, orthodromic AV reciprocating tachycardia using accessory pathway in 97 patients, antidromic AV reciprocating tachycardia in 11 patients, and atrial reentry in 39 patients). The stimulation protocol included one and two extrastimuli during sinus rhythm and after a pacing drive at different cycle lengths. The electrophysiological mechanism of tachycardias was determined by surface ECG, VA interval (esophageal lead), initiation mode at programmed transesophageal stimulation and by behavior of AV conduction and refractoriness. In 29 patients the mechanism of tachycardia was not clear. Invasive electrophysiological study was done in 219 of these 251 patients. In only nine patients, the supposed mechanism of tachycardia was not confirmed by invasive investigation. In 11 patients, the electrophysiological mechanism remained uncertain. In conclusion, the noninvasive transesophageal pacing is an appropriate method for evaluation of supraventricular tachycardia. It allows serial drug testing in a simple manner for finding an effective antiarrhythmic treatment.